Although they both carry the Medicare name, Medicare Part A and Part B are very different in terms of coverage and costs. Medicare Part A covers hospital expenses, hospice, and home health care. Medicare Part B, on the other hand, covers outpatient medical care such as doctor visits, x-rays, bloodwork, and routine preventative care. The two programs function as two halves of a comprehensive healthcare solution.
What is Medicare Part A?
Medicare Part A is sometimes referred to as “hospital insurance.” As the name implies, this is the Medicare plan that covers hospital stays and inpatient treatment. For treatment to be covered by Medicare Part A, it must be deemed medically necessary. This means a doctor has agreed that the treatment is required to prevent or treat a condition or illness.
What is Medicare Part B?
Medicare Part B is known as “medical insurance” because it covers doctor visits and medical care outside the hospital. Like with Medicare Part A, treatment must be determined as medically necessary or preventative to be covered by Medicare Part B.
Coverage differences between Part A and Part B
What does Medicare Part A cover?
Medicare Part A essentially covers inpatient medical care:
- Home health services, including nursing care, physical therapy, and occupational therapy
- Hospice, which is care aimed at making terminally ill individuals as comfortable as possible after they decide they no longer want to pursue treatment for their illness
- Hospital care, including long-term care facilities and inpatient rehab
- Nursing home care, but only if the beneficiary requires more than custodial care
- Skilled nursing facility care, including meals, supplies, and nurse-administered injections
What does Medicare Part B cover?
Medicare Part B covers outpatient medical services:
- Ambulance services, including the ride and any medical care administered
- Doctor’s office visits
- Durable medical equipment, or DME, which is equipment such as wheelchairs, walkers, and bathtub transfer benches
- Bloodwork and lab tests
- Mental health and substance abuse treatment.
- Outpatient surgery, which is surgery where you return home the day of the procedure rather than staying in a hospital or facility to recover
Medicare Part B also covers a variety of preventive care services:
- Tobacco cessation therapy
- Annual wellness visits
- Nutrition therapy
- Flu shots
- Diabetes screenings
- Cancer screenings
- HIV and STD screenings and counseling
Preventive care is care intended to prevent disease, rather than treat disease after it has occurred.
What is not covered by either plan?
There are some services and items that Medicare Part A and Part B don’t cover. If you need any of these services, you’ll be responsible for paying the costs yourself unless you have additional insurance or a different Medicare health plan that covers them. Some services Medicare doesn’t cover include the following:
- Cosmetic surgery
- Eye exams for prescription glasses
- Hearing aids and related exams
- Long-term custodial care
- Most dental care
- Routine foot care
If you require any of these services, you may want to consider switching to a Medicare Advantage Plan that offers additional coverage beyond Original Medicare, which is a common term for Part A and Part B combined.
Cost differences between Part A and Part B
What does Medicare Part A cost?
Many are eligible for premium-free Part A, which is exactly what it sounds like—qualified beneficiaries aren’t required to pay a premium for Part A coverage. To be eligible for premium-free Part A coverage, you must be over age 65 and meet one of the following requirements:
- You or your spouse paid Medicare taxes while employed with the government.
- You are eligible for Social Security or Railroad Retirement Board benefits but haven’t started collecting them yet.
- You currently receive retirement benefits from Social Security or the Railroad Retirement Board.
If you are under age 65, you might still be eligible for premium-free benefits if you meet one of two requirements:
- You have received Social Security or Railroad Retirement Board benefits for two years.
- You have End-Stage Renal Disease (ESRD).
If you don’t meet any of the five requirements above, you’ll have to pay a premium for Part A. For 2017, the premium is $413 per month. Additional costs with Part A include coinsurance in specific situations and a yearly deductible of $1,316 to cover any inpatient care.
What does Medicare Part B cost?
Medicare Part B, on the other hand, requires a monthly premium. The premium for 2017 starts at $134 per month and increases with income. You can choose to have this premium deducted automatically from your Social Security benefits, which can make things easier.
The deductible for Part B is just $183 per year. Once this is paid, you’ll only pay your coinsurance payments, which are 20% of covered expenses.
If you need help deciding what Medicare options are right for you, take a look at our Suggest-a-Plan tool. This simple tool can recommend a plan based on some basic information about you and the types of care you need.